1983, 07-07 Permit: 83A-6262 ResidencePLAN NUMBER APPL ICAT ION /PERMIT
SPbKANE COUNTY — DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456-3675
�--' APPLICANT: COMPLETE NUMBERED SPACES — PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
PARCEL NO.
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LOT BLOCK SUBDIVISION LEGAL DESCRIPTION:
2. 14- -5 StZ V E w cis
OWNER PHONE PHONE
3. plc. 2�
MAILING ADDRE
ltd C�RAI�v'+Et,}
ZIP
Actual Set Backs in Feet to:
p�
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Planning
ct'104
North 13` South '5�
East ZS' West
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
Zone Classification
4
Utilities
(�
1Z -4
C-mercial ❑
ADDRESS
�m
ZIP
T �0nst.
Occupy
Sprinklered
t(a4W
aV--lV
tU3 m .�
❑Yes ❑No ❑Req'd.
DESIGNER
PHONE
yyj�wwConst. Valuation
Remodeled Valuation
Total Bldg. Floor Area
5.
`�►s''� 2� �i
i$t8
ADDRESS
ZIP
Main Floor Upper
Floors
Garetora
�j
Greenhouse
6. CHANGE OF USE FROM
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE
�• OF 1A EW ❑ ALT. ❑ AD' N. ❑ RPL. ❑ MVE.
No. Baths No.
--�
Floors
1
No. Fin. Rooms
No. Dwellings
WORK I -W ❑ PLMB. ❑ MECH. ❑ M.H. ❑ POOL ❑OTHER
Certifi. of Exempt.
Required Yes❑ No
1
Number
WOP'<
or Variance
Received Yes❑ No❑12
8. DESCRIBE
Shorelines/ Flood Hazard
Plans R ulred
yes Not Applic. ❑
Received rl
VALUATION
9.
SOURCE
GAS
ELECTRIC
WATE
SEWAGE
Ownership
UTILITIES
PRIVATE
SEWER O
Public ❑ Private
FEES COLLECTED
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
Building
thority to violate or cancel the provisions of any other state or local law regulating construction or the performance
of construction. SEE REVERSE SIDE FOR REQUIRED INSPECTIONS
Plumbing
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
Mech.
SPECIAL APPROVALS
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
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Planning
Fire
Prevent.
Engineer
c n
Utilities
SEPA
Plans
Exam.
t(a4W
Building
Tech.
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $ —5- Vv
WHEN MACHINE VALIDATED IN
THIS BECOMES A PERMIT.
PE RMI NUMBER
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DATE�SSUED' / _ PERMIA` 6. 2 d *350.00'
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